1073758298 NPI number — BAPTIST SURGERY AND ENDOSCOPY CENTERS LLC

Table of content: (NPI 1073758298)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073758298 NPI number — BAPTIST SURGERY AND ENDOSCOPY CENTERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAPTIST SURGERY AND ENDOSCOPY CENTERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
BAPTIST HEALTH ENDOSCOPY CENTER AT GALLOWAY NORTH
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1073758298
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6855 RED ROAD
Provider Second Line Business Mailing Address:
STE 500
Provider Business Mailing Address City Name:
CORAL GABLES
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33143-3623
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
786-662-7980
Provider Business Mailing Address Fax Number:
786-533-9403

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7500 SW 87TH AVE STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MIAMI
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33173-5426
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
305-595-9511
Provider Business Practice Location Address Fax Number:
305-271-0383
Provider Enumeration Date:
12/03/2008

Additional Information

Authorized Official

Authorized Official Last Name:
BATISTA-RODRIGUEZ
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
786-662-7111

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QE0800X , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 000788200 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 68-00264 . This is a "UNITED MEDICARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 16092 . This is a "MEDICA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 2558072 . This is a "UNITED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1211778 . This is a "AETNA HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: F00255807203 . This is a "NEIGHBORHOOD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 602 . This is a "BLUE CROSS BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7325793 . This is a "AETNA NON-HMO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 298398 . This is a "AVMED" identifier . This identifiers is of the category "OTHER".
  • Identifier: 019676700 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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